Afraid of Spiders? When Telangiectasia is More than just Spider Veins


Telangiectasia is more commonly known as spider veins, the generally innocuous cousin to varicose veins. Whereas varicose veins are the large rope-like weakened veins that carry the greater risk of deep-vein thrombosis, spider veins tend to be the damaged blood vessels just below the surface of the skin, appearing like tiny purple spider webs.

But does that mean there’s never a risk with telangiectasia?

There are a few circumstances when spider veins may be a symptom of something else at work in the body.

One condition is called hereditary hemorrhagic telangiectasia (HHT), sometimes called Osler-Weber-Rendu syndrome. This is hereditary and rare, but HHT is a disorder that involves multiple abnormalities in the blood vessels, as well as arteriovenous malformations, including in the liver, lungs, and brain. Patients with HHT may also experience gastro-intestinal bleeding.

Normally, blood carrying oxygen to the heart from the lungs is pumped at high pressure into the arteries, which allows the blood to get from the arteries into the smaller vessels and capillaries at a much lower pressure, where the blood will supply the body’s tissues with oxygen. Then, the blood goes from the capillaries into the veins and then back to the heart.

However, with HHT, arteriovenous malformations occur, which means that arterial vessels flow straight to the veins instead of through the capillaries, and when it presents near the skin’s surface, they appear as red markings—telangiectases, or spider veins. Because the capillaries act as a buffer, slowing down the blood pressure, the blood flows at a high pressure straight to the veins, which are less elastic and thinner-walled. Because of the extra pressure on the venous walls, blood vessels are strained and enlarged, which can irritate or compress adjacent tissues. Sometimes HHT can cause frequent and even severe hemorrhage, including nosebleeds. If this is the case, frequently there is also hemorrhaging in organs such as the liver, lungs, and brain.

There are different types of HHT, some of which present symptoms earlier, or may involve common bleeding or leakage in different organs. Frequently, patients with HHT develop reddish-purple mucocutaneous lesions, especially in the nose, lips, and tongue. But these lesions also may occur in the upper respiratory tract, the GI tract, and in some cases, even the bronchi, bladder, and vagina. Acute hemorrhage or chronic slow bleeding may lead to anemia. In extreme cases, arteriovenous malformations in the respiratory system—pulmonary AVMs—may cause stroke, high-output heart failure, or cerebral abscess. AVMs of the liver can also cause high-output cardiac failure or cirrhosis.

Somewhere between 1 in 5,000 and 1 in 8,000 people have a form of HHT. HHT often doesn’t present symptoms until the teenage years. However, it often goes undiagnosed or misdiagnosed. In one study involving patients with HHT, 74% had vascular abnormalities but only 8% showed symptoms.

So should you worry at the first sign of spider veins? Of course not. But it is important to be alert to what your body is telling you. Most cases of telangiectasia occur because of heredity and normal pressure on the veins. Patients with HHT benefit from early diagnoses, and unless there is cirrhosis of the liver or a severe hemorrhage, rarely is there an effect on lifespan. What you should remember is how much the body is interconnected, organs and tissues working together, with the circulatory system feeding all of them. While you don’t want to become a hypochondriac, it’s also important not to put off any diagnosis or treatment. Keep your doctor apprised of any changes in your body, especially if lesions form or regular abnormal bleeding occurs.

And for those with arachnophobia, we understand that while most spiders are harmless, sometimes you still want to get rid of them. At SD Vein Institute, we make it virtually painless and easy to do, even on a lunch break visit. If you want to know more about laser therapy or sclerotherapy, contact us at 760-944-9263 or visit us at